Background The NICE 2007 guidelines for antenatal and postnatal mental health suggested that women are screened by midwives at booking to identify a past history or ongoing history of perinatal mental ill-health.1 We hypothesised that the main barrier to accurate identification was a lack of confidence in the clinical pathway, as opposed to lack of skill in asking the questions.2,3 We introduced a simplified and formalised triage system at St. Michael’s Hospital, Bristol, in 2012.
Method An “at risk” fax notification form was completed by midwives for those women who screened positive using the ‘Whooley’ questions. This information was triaged and streamlined patients to either an antenatal appointment or to the appropriate support services. Referral data were analysed from January 2012 to July 2013.
Results The most common conditions referred included depression (55%), anxiety (19%), eating disorders (6%) and bipolar disorder (5%). 68% were referred onto a consultant-led antenatal clinic, 26% were for information only and a letter sent to the midwife to refer back if necessary and 5% were referred to the New Horizon Mother and Baby Centre. During the period January 2013 to July 2013 there were a total of 158 referrals using the ‘at risk’ notification form compared with 53 referrals in the previous 6 months. The number of words per referral increased significantly demonstrating an increase in the detail recorded.
Conclusion We concluded that when midwives have confidence in the referral pathway they were more empowered to identify women at risk of perinatal mental ill-health.
Antenatal and Postnatal Mental Health. The NICE guideline on clinical management and service guidance. The British Psychological Society and Royal College of Psychiatrists, 2007
Ross-Davie M, Elliott S, Sarkar A, Green L. A public health role in perinatal mental health. Are Midwives ready? British Journal of Midwifery, 2006 Jun;14(6):330–334
McCauley K, Elsom S, Muir-Cochrane E, Lynehm J. Midwives and assessment of perinatal mental health. J Pschiatr Mental Health Nurs. 2011 Nov;18(9):786–95
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